Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy?
Is reducing variability of blood glucose the real but hidden target of intensive insulin therapy?
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DOI：
10.1186/cc7755
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发表时间：
2009
期刊：
影响因子：
--
通讯作者：
Reade MC
中科院分区：
文献类型：
--
作者：
Egi M;Bellomo R;Reade MC
自从第一篇关于强化胰岛素治疗降低外科危重患者死亡率的报道以来，降低血糖水平被推荐为改善患者预后的一种手段。在这项最初的鲁汶试验中，98.7%的强化组患者采用胰岛素方案控制血糖，而对照组患者只有39.2% （P < 0.0001）。如果应用得当，这些方案应降低平均血糖浓度及其变异性（血糖浓度的变化）。因此，从逻辑上讲，在第一次鲁汶试验中，强化胰岛素治疗的益处可能是由于平均血糖水平的降低，或其可变性的降低，或两者兼而有之。最近的几项研究证实了血糖水平变异性与患者预后之间的显著关联。降低血糖水平的可变性可能是血糖管理的一个重要方面，是强化胰岛素方案发挥其预期有益作用的可能机制，也是重症监护病房血糖管理的一个重要目标。临床医生在考虑强化胰岛素治疗的应用和解释未来的试验时需要意识到这一争议。
Since the first report that intensive insulin therapy reduced mortality in selected surgical critically ill patients, lowering of blood glucose levels has been recommended as a means of improving patient outcomes. In this initial Leuven trial, blood glucose control by protocol using insulin was applied to 98.7% of patients in the intensive group but to only 39.2% (P < 0.0001) of patients in the control group. If appropriately applied, such protocols should decrease both the mean blood glucose concentration and its variability (variation of blood glucose concentration). Thus, it is logically possible that the benefit of intensive insulin therapy in the first Leuven trial was due to a decrease in mean glucose levels, a decrease in their variability, or both. Several recent studies have confirmed significant associations between variability of blood glucose levels and patient outcomes. Decreasing the variability of blood glucose levels might be an important dimension of glucose management, a possible mechanism by which an intensive insulin protocol exerts its putative beneficial effects, and an important goal of glucose management in the intensive care unit. Clinicians need to be aware of this controversy when considering the application of intensive insulin therapy and interpreting future trials.
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影响因子：
8.8
作者：
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通讯作者：
Ketzler, JT
影响因子：
8.8
作者：
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影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
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通讯作者：
Krinsley, James S.
DOI：
10.1186/cc7097
发表时间：
2008
期刊：
Critical care (London, England)
影响因子：
--
作者：
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通讯作者：
Quintel M